University of California, San Francisco
c/o California Poison Control System
San Francisco Division, Box 1369
San Francisco, CA 94143-1369
University of California, Irvine
Center for Occupational & Environmental Health
5201 California Avenue, Suite 100
Irvine, CA 92617
415-206-4320
949-824-1857
Health Risks of Wildfires for Children – Acute Phase
James M. Seltzer, M.D., Mark Miller, M.D., M.P.H., and Diane L. Seltzer, M.A.
Pediatric Environmental Health Specialty Unit (PEHSU) Region IX
University of California, Irvine School of Medicine
University of California, San Francisco
October 28, 2007
Children are especially vulnerable to environmental hazards. They eat more food, drink
more liquids, and breathe more air than adults on a pound for pound basis. Children are
in a critical period of development when toxic exposures can have profound negative
effects, and their exploratory behavior often places them in direct contact with
materials that adults would avoid.
Wildfires expose children to a number of environmental hazards, e.g., fire, smoke,
psychological stimuli, and the byproducts of combustion of wood, plastics, and other
chemicals released from burning structures and furnishings. During the acute phase of
wildfire activity, the major hazards to children are fire and smoke. Acute stress from fire
activity and response to the fires and the emotional responses of those around them
can also impact children during this time.
The acute phase environmental hazards for children and their family are
highlighted below.
•
SMOKE consists of very small organic particles, liquid droplets, and gases such as
CO, CO2, and other volatile organic compounds, such as formaldehyde and
acrolein; actual contents depends upon the fuel source
•
HEALTH EFFECTS OF SMOKE: Common health effects in children from smoke
include eye and respiratory tract irritation, reduced lung function, and worsening
of pre-existing lung or cardiovascular disease, e.g., asthma. As a result of
inflammation of the lungs and effects on the heart and blood vessels, the
consequences of smoke inhalation can include chest tightness, shortness of
breath, wheezing, coughing, respiratory tract and eye burning, chest pain,
dizziness or lightheadedness, and other symptoms. The development of ill health
effects also depend upon the fuel source (what is burning), duration and extent
of exposure, and health of the exposed individual. The risk of developing cancer
from short-term exposures is vanishingly small.
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POPULATIONS AT INCREASED RISK: Includes individuals with pre-existing lung or
cardiovascular problems, pregnant women, children, elderly, and smokers.
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CHILDREN ARE NOT JUST SMALL ADULTS. Their lungs are still in the process of
developing and their airways are narrower than adults. They spend more time
outdoors, they inhale more air per pound of body weight, and they engage in
more vigorous activity outside. As a result, they are more susceptible to the
health effects of smoke.
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RECOMMENDATIONS
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MINIMIZE PERSONAL SMOKE EXPOSURE
•
Stay indoors: with windows and doors closed and any gaps in
the building envelope sealed
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If available and if needed for comfort, run an air-conditioner
on the “re-circulate” setting. Be sure to change the filter at
appropriate intervals to keep it working efficiently
If there is a period of improved air quality, open up (air out)
the house and clean to remove dust particles that have
accumulated inside.
Avoid indoor activities that may add to indoor air
contamination, e.g., cooking with gas or propane stoves,
smoking, vacuuming (if you do not have a HEPA filter
vacuum or central vacuum system), burning wood stoves or
furnaces.
Additional room or central air filtration systems may help
remove airborne particles, but they need to be selected to
adequately filter the area in which they serve and be of the
right technology. Some electronic air cleaners and ozone
generating “filters” can generate dangerous amounts of
ozone indoors. (See “Wildfire smoke” reference”). These
filtration systems do not remove harmful contaminants from
the air and are not recommended.
Humidifiers or breathing through a wet washcloth may be
useful in dry climates to keep mucous membranes moist,
although this does nothing to reduce airborne contaminant
inhalation.
Reduce activity, e.g., don’t exercise, to reduce the amount
of air contaminants you inhale
When riding in a car, keep the windows and vents closed. If
comfort requires air circulation, turn the air-conditioning on
“re-circulate” to reduce the amount of outside air drawn into
the car.
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Masks
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People in a “high risk” group should find an adequate “clean
air” shelter, which may be in their home, in the home of a
friend or relative, or in a publicly-provided “clean air” shelter.
Paint, dust, and surgical masks are not effective obstacles to
inhalation of the fine airborne particles generated by
wildfires.
Masks that filter out 95% of particles measuring 0.3
micrometers diameter or larger can be effective if properly
fitted to the wearer’s face. They are available at hardware
stores and from mail order catalogues, and are usually
termed “N95”. Even more efficient masks, e.g., “N99” or
“N100”, are also available. Full-face and half-face respirators
with HEPA filter cartridges that efficiently filter out the fine
airborne particles in smoke as well as some gases can be
purchased, but are significantly less comfortable than the
masks.
No mask is effective unless it is fitted properly. Any of these
masks can be uncomfortable to wear and breathe in for any
extended period of time. Some brands produce masks for
various sized faces.
Although smaller sized masks may appear to fit a child’s
face, none of these manufacturers recommend their use in
children. If your child is in air quality severe enough to
warrant wearing a mask, you should remove them to an
indoor environment with cleaner air.
You should change your mask when it gets dirty. Usually,
this is obvious by a color change in the mask or you can feel
an increased resistance to breathing.
A list of NIOSH (National Institute of Occupational Safety
and Health) approved and commonly available N-95
respirators can be found at
http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part
/n95list1.html.
Air Quality Index
The Air Quality Index (AQI) provides an indicator of how dangerous the
air is to breathe based upon the measurement of various ground level
pollutants, such as ozone and small particles (PM2.5). The smoke from
wildfires contains large amounts of these hazardous small particles (0.4 –
0.7 micrometers in diameter). In areas where the AQI is not determined,
measuring PM2.5 is a good substitute for determining the air quality.
Ranges of the AQI index or PM2.5 concentrations reflect how dangerous it
is to breathe the air:
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Level of Health Concern
AQI Index
PM2.5 Level
Good
Moderate
Unhealthy for
Sensitive Groups
Unhealthy
Very Unhealthy
Hazardous
0 – 50
51 – 100
101 – 150
0 – 40
41 – 80
81 – 175
151 – 200
201 – 300
> 300
176 – 300
301 – 500
>500
Recommended actions for healthy and sensitive populations for each
level of air quality can be found in the Wildfire Smoke and Air Quality
Index references cited below. Your current air quality index can be found
at http://www.airnow.gov.
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MINIMIZE OUTDOOR ACTIVITY. Outdoor activity should be minimized and
athletic and physical education halted, until air quality improves
sufficiently to a level that does not put children’s health at risk. Children
predisposed to greater sensitivity to smoke exposure should be kept
indoors until air quality has returned to baseline for the area.
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CLOSING OF SCHOOLS AND BUSINESSES may become necessary because of
smoke exposure risk (not considering the risk of nearby fires) when air
quality is so poor that even traveling between indoor locations places
people at risk. However, in some situations the school may be a relatively
protected indoor environment with better air quality and where children’s
activity can be monitored
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CONSIDERATION OF EVACUATION because of smoke exposure should weigh
the degrees of smoke exposure likely during an evacuation versus what
the exposure would be resting quietly inside one’s home. If evacuation is
required because of very poor air quality or nearby fires, community
resources should be positioned to assist with an orderly and safe exit from
the smoke/fire zone. The smoke can significantly impair visibility. A
disorderly evacuation can unnecessarily increase the duration and extent
of smoke exposure. Remember to bring with you at least 5 days of any
medications taken by family members.
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People in an INCREASED RISK OR “SENSITIVE” GROUP should monitor
themselves or be monitored closely for smoke exposure risk and also for
signs or symptoms of the adverse health effects described above. Despite
the risks of traveling, someone who is showing evidence of a smokerelated pre-existing or even new illness, and who cannot bring this under
control with self-treatment, should seek medical care at a nearby facility
with appropriate measures to minimize smoke exposure en route.
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•
ASH: The recent fires have deposited large amounts of ash on indoor and
outdoor surfaces in areas near the fire. This ash may be irritating to the
skin and may be irritating to the nose and throat and may cause
coughing. The following steps are recommended (complete steps are
available in the full document, above):
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Do not allow children or animals to play in ash.
Wear gloves, long sleeved shirts, and long pants when handling
ash, and avoid skin contact.
Wash any home-grown fruits or vegetables before eating.
Avoid spreading the ash in the air; wet down the ash before
attempting removal; do not use leaf blowers or shop vacuums.
Avoid washing ash into storm drains.
Collected ash may be deposited in the regular trash in plastic bags.
PSYCHOLOGICAL EFFECTS ON CHILDREN: During the acute phase, parents
and caregivers should also be alert to children’s emotional health and
psychological wellbeing. It is important to keep in mind the youngest
members of our society may easily become saturated with graphic
pictorial images and incessant talk of smoke, flames and destruction.
Resulting stress and anxiety may be manifested in a variety of ways,
depending upon the developmental stage of an individual child:
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Clinging
Uncooperative
behaviors
Nightmares
Physical complaints
Irritability
Fears
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Changes in eating or sleeping
patterns
Regression
Indifference
Parents and caregivers can support children in a number of ways,
beginning with maintaining previously established routines and structures
as much as possible.
Provide an open door and a listening ear for children; encourage the
expression of feelings through a variety of pathways, e.g., music, art,
journaling, talking. Answer questions openly and honestly, remaining
mindful the age of the child will determine how information is shared.
Reassure and hug when hugs are wanted; practice patience and adopt a
peaceful demeanor, as children take their cues from the clues given by
their parents and the environment.
To contact your local Pediatric Environmental Health Specialty Unit with any questions
about this fact sheet please visit http://www.aoec.org/PEHSU.htm.
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RESOURCES
More details on the health effects of wildfires and ash cleanup are available at the
following sites, from which some of this material was adopted:
Wildfire Smoke – A Guide for Public Health Officials:
www.oehha.ca.gov/air/risk_assess/wildfirev8.pdf
Safe Clean up of Fire Ash: www.calepa.ca.gov/Disaster/Documents/FireAsh.pdf
Enviro-Health Links – California Wildfires (National Library of Medicine):
sis.nlm.nih.gov/enviro/californiafires.html#a1
AirNow: www.airnow.gov
Air Quality Index – A Guide to Air Quality and Your Health:
airnow.gov/index.cfm?action=aqibroch.aqi#2
We would like to thank members of the PEHSUs nationwide and members of the Committee on
Environmental Health of the American Academy of Pediatrics for their assistance reviewing this
fact sheet.
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